Tracheostomy has some advantages, including reducing ineffective cavities and airway resistance，offering improved comfort, and more convenient oral care and clearance of respiratory secretions, etc. But tracheostomy may cause some complications, especially the posterior tracheal wall laceration that may cause fatal consequences. This article reports a posterior tracheal wall laceration case during tracheostomy, which happened in an oral cancer surgery. Here we summarize the anesthesia managing experience to provide a reference for the perioperative management of tracheostomy.